Objective To investigate the clinical features of glial fibrillary acidic protein immunoglobulin G （GFAP-IgG）-associated myelitis， to compare the differences in clinical features between GFAP-IgG-associated myelitis and aquaporin-4 immunoglobulin G （AQP4-IgG）-associated myelitis/myelin oligodendrocyte glycoprotein immunoglobulin G （MOG-IgG）-associated myelitis， and to provide help for early diagnosis and treatment. Methods A retrospective analysis was performed for the clinical data of 34 patients who were diagnosed with GFAP-IgG-associated myelitis in The First Affiliated Hospital of Zhengzhou University and Henan Children Hospital from May 2018 to May 2023， and their demographic features， clinical features， serological parameters，cerebrospinal fluid （CSF） parameters， imaging features， and prognosis were systematically analyzed. In addition， 30 patients diagnosed with AQP4-IgG-associated myelitis and 42 patients diagnosed with MOG-IgG-associated myelitis during the same period of time were enrolled as control groups， and the mean clinical features were compared between the three groups. Results Among the 34 patients with GFAP-IgG-associated myelitis， there were 15 female patients and 12 children. The median age of onset was 28.5 years， and more than half of the patients had prodromal symptoms. More than half of the patients had the symptoms of pyrexia （29/34， 85%）， headache （19/34，56%）， nausea/vomiting （20/34，59%），and limb weakness （27/34，79%） during the course of the disease， with 19 patients（19/34，56%） admitted to the intensive care unit （ICU）.Imaging examination showed gadolinium-enhancing spinal cord lesions and longitudinally extensive sagittal T2 hyperintensity， i.e.，longitudinally extensive transverse myelitis.Compared with the AQP4-IgG-associated myelitis group and the MOG-IgG-associated myelitis group，the GFAP-IgG-associated myelitis group had a significantly higher proportion of patients with pyrexia （85% vs 10%， P1<0.01； 85% vs 38%，P2<0.01）， neck stiffness （41% vs 7%， P1<0.01； 41% vs 12%， P2<0.01）， admission to the ICU （56% vs 10%， P1<0.01； 56% vs 17%， P2<0.01）， or mechanical ventilation （38% vs 3%， P1<0.01； 38% vs 0%， P2<0.01） and a significant increase in serum monocyte-to-lymphocyte ratio [0.43（0.24，0.71） vs 0.23 （0.18，0.32）， P1<0.01； 0.43 （0.24，0.71） vs 0.21 （0.14，0.30），P2<0.01]， as well as a significantly higher proportion of patients with hyponatremia （45% vs 13%，P1<0.01； 45% vs 7%，P2<0.01）， an increase in leukocyte count in CSF（68% vs 14%， P1<0.01； 68% vs 34%， P2<0.01）， an increase in total protein in CSF （82% vs 31%， P1<0.01； 82% vs 20%， P2<0.01）， a reduction in glucose level in CSF （26% vs 3%，P1=0.03； 26% vs 2%， P2<0.01）， or the presence of central canal enhancement （29% vs 0%， P1=0.02；29% vs 0%， P2=0.01）. Compared with the AQP4-IgG-associated myelitis group， the GFAP-IgG-associated myelitis group had a significantly higher number of the diseased segments of spinal cord [13（5.8，18） vs 6（3，12.5），P=0.01]. Compared with the MOG-IgG-associated myelitis group， the GFAP-IgG-associated myelitis group had a significantly higher EDSS score at discharge [4（3，6） vs 1（0，3），P2=0.01] and at last follow-up [0（0，2.8） vs 0（0，1），P2=0.047]. Conclusion There are differences in clinical features， serological/CSF profiles， and imaging features among the three groups of patients with myelitis，which may help with the differential diagnosis of the different subtypes of myelitis.
Myelitis

Objective:To explore the application value of radiomics models based on MRI of vertebrae and paravertebral muscles in identifying potential vertebral fragility fracture risk in osteoporosis and osteopenia.Methods:This cross-sectional study collected data from patients who underwent both dual-energy X-ray absorptiometry (DXA) and lumbar MRI at the Third Affiliated Hospital of Southern Medical University between January 2014 and December 2023,retrospectively. Based on DXA results, patients were categorized into osteoporosis group ( n=302) and osteopenia group ( n=264), with fracture and non-fracture patients matched at 1∶1 ratio by propensity score matching based on age, gender, and body mass index. The fourth lumbar vertebra was selected as the region of interest (ROI) for the vertebral body, and the bilateral psoas major, erector spinae, and multifidus muscles were selected as the ROIs for the paraspinal muscles. A total of 7 259 radiomics features were extracted from these ROIs. The dataset was divided into a training set and a test set in an 8∶2 ratio by simple random sampling (osteoporosis group 241 and 61 cases, osteopenia group 211 and 53 cases). The T-score was used to establish the clinical model. After feature normalization and dimensionality reduction, logistic regression was applied to build three radiomics models: vertebral model, paraspinal muscle model, and vertebral-paraspinal muscle model. The T-score was then combined with the radiomics model that achieved the highest area under the receiver operating characteristic curve (AUC) in the test set to construct a clinical-radiomics combined model. Model performance was evaluated using the AUC. The DeLong test was used to compare the diagnostic efficacy between models. Results:In the test set, the vertebral-paravertebral muscle model achieved the highest AUC among radiomics models and was selected for combination with the T-score. In identifying potential vertebral fragility fractures of osteoporosis group, the AUC (95% CI) of the clinical model, vertebral model, paraspinal muscle model, vertebral-paraspinal muscle model, and clinical-radiomics model were 0.523 (0.373-0.672), 0.869 (0.779-0.959), 0.608 (0.464-0.752), 0.876 (0.791-0.961), and 0.860 (0.769-0.952), respectively. For osteopenia group, the corresponding AUC(95% CI) were 0.625 (0.467-0.783), 0.696 (0.547-0.845), 0.706 (0.563-0.848), 0.816 (0.702-0.930), and 0.820 (0.710-0.930). The DeLong test showed that the vertebral model for identifying the potential vertebral fracture risk in osteoporosis group had better performance than the paraspinal muscle model ( Z=3.28, P=0.001). While for osteopenia group, there was no significant difference in diagnostic performance between the vertebral model and the paraspinal muscle model ( Z=0.09, P=0.932). The recognition efficacy of the clinical model and the vertebral-paraspinal muscle model was significantly different ( Z=3.69, 1.98; P<0.001, P=0.047), while there was no significant difference between the clinical-radiomics combined model and the vertebral-paraspinal muscle model ( Z=1.51, 0.12; P=0.131, 0.904). Conclusion:The MRI-based vertebral-paraspinal muscle radiomics model can effectively identify osteoporosis or osteopenia patients with potential fragility fracture risk. In osteopenia group, the efficacy of the MRI radiomics models based on the vertebra and paraspinal muscles in identifying potential vertebral fragility fracture risk is comparable.

Objective:To explore the application value of radiomics models based on MRI of vertebrae and paravertebral muscles in identifying potential vertebral fragility fracture risk in osteoporosis and osteopenia.Methods:This cross-sectional study collected data from patients who underwent both dual-energy X-ray absorptiometry (DXA) and lumbar MRI at the Third Affiliated Hospital of Southern Medical University between January 2014 and December 2023,retrospectively. Based on DXA results, patients were categorized into osteoporosis group ( n=302) and osteopenia group ( n=264), with fracture and non-fracture patients matched at 1∶1 ratio by propensity score matching based on age, gender, and body mass index. The fourth lumbar vertebra was selected as the region of interest (ROI) for the vertebral body, and the bilateral psoas major, erector spinae, and multifidus muscles were selected as the ROIs for the paraspinal muscles. A total of 7 259 radiomics features were extracted from these ROIs. The dataset was divided into a training set and a test set in an 8∶2 ratio by simple random sampling (osteoporosis group 241 and 61 cases, osteopenia group 211 and 53 cases). The T-score was used to establish the clinical model. After feature normalization and dimensionality reduction, logistic regression was applied to build three radiomics models: vertebral model, paraspinal muscle model, and vertebral-paraspinal muscle model. The T-score was then combined with the radiomics model that achieved the highest area under the receiver operating characteristic curve (AUC) in the test set to construct a clinical-radiomics combined model. Model performance was evaluated using the AUC. The DeLong test was used to compare the diagnostic efficacy between models. Results:In the test set, the vertebral-paravertebral muscle model achieved the highest AUC among radiomics models and was selected for combination with the T-score. In identifying potential vertebral fragility fractures of osteoporosis group, the AUC (95% CI) of the clinical model, vertebral model, paraspinal muscle model, vertebral-paraspinal muscle model, and clinical-radiomics model were 0.523 (0.373-0.672), 0.869 (0.779-0.959), 0.608 (0.464-0.752), 0.876 (0.791-0.961), and 0.860 (0.769-0.952), respectively. For osteopenia group, the corresponding AUC(95% CI) were 0.625 (0.467-0.783), 0.696 (0.547-0.845), 0.706 (0.563-0.848), 0.816 (0.702-0.930), and 0.820 (0.710-0.930). The DeLong test showed that the vertebral model for identifying the potential vertebral fracture risk in osteoporosis group had better performance than the paraspinal muscle model ( Z=3.28, P=0.001). While for osteopenia group, there was no significant difference in diagnostic performance between the vertebral model and the paraspinal muscle model ( Z=0.09, P=0.932). The recognition efficacy of the clinical model and the vertebral-paraspinal muscle model was significantly different ( Z=3.69, 1.98; P<0.001, P=0.047), while there was no significant difference between the clinical-radiomics combined model and the vertebral-paraspinal muscle model ( Z=1.51, 0.12; P=0.131, 0.904). Conclusion:The MRI-based vertebral-paraspinal muscle radiomics model can effectively identify osteoporosis or osteopenia patients with potential fragility fracture risk. In osteopenia group, the efficacy of the MRI radiomics models based on the vertebra and paraspinal muscles in identifying potential vertebral fragility fracture risk is comparable.

Objective To summarize and evaluate the characteristics of current recurrent spontaneous abortion(RSA)animal models at home and abroad,and to provide reference and guidance for the standardized preparation of RSA models.Methods"Recurrent spontaneous abortion"and"animal model"were used as co-keywords in CNKI,Wanfang,VIP,PubMed and Web of Science databases to search the RSA animal experimental literature,covering the period up to January 20,2024,and a total of 1 411 articles were collected.The analysis focused on construction methods and essential elements of RSA animal models,the modeling process and result evaluation,as well as the application of these models in pharmacological and pharmacodynamic research.An Excel table was established for systematic analysis and discussion.Results A total of 138 experimental studies were obtained after screening.In constructing RSA animal models,immunological models were the most widely used in Western medicine(96.92％),with the Clark model being the main one(92.31％).In traditional Chinese medicine(TCM)models,70.00％were kidney deficiency-luteal inhibition-syndrome combination models,20.00％were kidney deficiency and blood stasis models,and 10.00％were deficiency-heat syndrome models.Most animals were selected at 6-8 weeks(33.86％)and 8 weeks(32.28％)of age.The majority of animals were paired for mating at 18:00 on the day of cage pairing.In 81.03％of literatures,vaginal plugs were checked once the following morning,with 8:00 being the most common time(17.02％).The most commonly used drug administration cycle was 14 days of continuous gavage after pregnancy.Among the tested drugs,Western drugs were mainly protein-based(29.17％),while TCM drugs were mainly TCM decoction(81.11％).The most frequently used methods for detecting indicators included visual observation of embryos(22.54％),western blot(15.96％),PCR(13.58％),ELISA(12.91％),HE staining(10.80％)and immunohistochemistry(9.39％).Conclusion The etiology of RSA is complex,and corresponding animal models should be established based on different etiologies.Clark model is commonly used in the construction of Western medicine model,while the kidney deficiency-luteal inhibition-syndrome combination model is predominant in TCM.RSA animal model is widely used in related research,but systematic evaluation needs to be strengthened.

“Deficiency cause， cold accumulation， and qi stagnation” originates from Essentials from the Golden Cabinet （《金匮要略》）， which is a guiding principle for the pathogenesis of women's diseases， pioneering the differentiation and treatment of women's diseases based on patterns， and having a profound influence on future generations. Following the classical principles and simplifying the complexities， this paper explored the pathogenesis and mechanism of polycystic ovary syndrome （PCOS） from the perspective of “deficiency cause， cold accumulation， and qi stagnation”， and believed that depletion of essence and blood， long-term accumulation of internal cold， and qi constraint and blood stasis are the causes of PCOS， with depletion of essence and blood， and lack of nourishment of zang-fu （脏腑） organs as the root， and cold pathogen invasion， qi constraint and blood stasis as the branch. The main treatment principle is “treating deficiency with supplementation”， and dispelling pathogen while reinforcing healthy qi， along with “treatment of cold by warming” and “treatment of stagnation by dispersing”. This is of great significance for the treatment of polycystic ovary syndrome. Clinically， these methods can be used flexibly to guide treatment and formula selection for PCOS， with the goal of harmonizing qi and blood and regulating menstruation.

Abstract: Objective To investigate the expression of T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) on the surface of T cells in patients with brucellosis (Bm), as well as the expression of interleukin-10 (IL-10) and transforming growth factor beta (TGF-β) in serum, and to analyze the differential expression of these indicators in patients with acute and chronic brucellosis, in order to provide new approaches for the differential diagnosis of acute and chronic brucellosis. Methods A total of 56 patients diagnosed with brucellosis at the First Affiliated Hospital of Xinjiang Medical University from April 2023 to September 2023 were selected, including 31 patients in the acute phase and 25 patients in the chronic phase. Additionally, 35 healthy individuals underwent routine physical examinations within the same period served as healthy controls. Flow cytometry was used to detect and compare Tim-3 levels on the CD4+ T cells' surface among the groups. Levels of serum IL-10 and TGF-β were measured and compared using CBA and ELISA, respectively, and the relationship of these factors with the staging of brucellosis patients was analyzed. Results The proportions of Tim-3+CD3+CD4+T cells in the control group, acute group, and chronic group were (2.56±1.25)%, (5.14±1.98)%, and (13.66±2.66)%, respectively. The Tim-3 levels in the patients with brucellosis were higher than those in the healthy control group, with the chronic group showing even higher levels, and these differences were statistically significant (P<0.05). The levels of IL-10 and TGF in the patient group were higher than those in the healthy control group, with the chronic group exhibiting significantly higher levels of IL-10 and TGF-β than the acute group, also presenting statistically significant differences (P<0.05). The areas under the ROC curve for predicting chronic brucellosis with Tim-3, IL-10, and TGF-β scores were 0.876, 0.865, and 0.663, respectively. Conclusions There are certain differences in the expression of Tim-3, serum IL-10, and TGF-β among patients with brucellosis, with high expression indicating a potential transition to the chronic phase of the disease. Tim-3 has shown the best diagnostic performance. Therefore, as a diagnostic indicator, Tim-3 may provide new ideas and strategies for the treatment and differential diagnosis of brucellosis.

Objective:To analyze the correlation between two-dimensional ultrasound and HbA1c, Thyroid stimulating hormone (TSH) and its diagnostic value in benign and malignant Thyroid nodules.Methods:A total of 155 patients with thyroid nodules examined in the Department of Ultrasound Medicine of Haikou Orthopedics and Diabetes Hospital from January 2020 to January 2021 were prospectively selected. With surgical pathological examination as the gold standard, they were divided into benign group (75 cases) and malignant group (80 cases) according to the nature of nodules. There were 40 males and 35 females in the benign group, with an age of (47.95±8.26) years old and BMI of (22.45±1.26) kg/m2. There were 42 males and 38 females in the malignant group, with an age of (48.22±8.01) years old and BMI of (22.36±1.21) kg/m2. The expression level of HbA1c was detected by automatic biochemical analyzer, and the concentration of TSH was detected by automatic immunoassay. SPSS 19.0 statistical software was used for analysis and processing.Results:Compared with benign thyroid nodules, the mean transit time (MTT) and time to peak intensity of malignant thyroid nodules were (0.92±0.11 vs 1.48±0.42) s and (1.48±0.42) s respectively. TIP (1.06±0.21 vs 1.57±0.56) s, perfusion Index (PI) (1.15±0.22 vs 1.76±0.62) s parameters increased, and the differences were statistically significant ( P < 0.05) . Compared with patients with benign thyroid nodules, the expression levels of HbA1c (6.98±0.73 VS 10.22±1.35) % and TSH (3.95±0.53 VS 8.75±0.95) mIU/L in patients with malignant thyroid nodules were significantly higher ( P<0.05) . The expression levels of MTT, TIP, PI, HbA1c, and TSH were correlated with those of benign and malignant thyroid nodules, and the expression levels of MTT, TIP, PI, HbA1c, and TSH were positively correlated with those of benign and malignant patients ( P<0.05) . MTT, TIP and PI had correlation with the expression levels of HbA1c and TSH. Positive correlation: MTT had a positive correlation with HbA1c and TSH. TIP had a positive correlation with HbA1c and TSH. PI had a positive correlation with HbA1c and TSH ( P<0.05) . Compared with the single diagnosis of MTT, TIP and PI, the three combinations had higher diagnostic value for malignant thyroid nodules ( P=0.001) . Conclusion:Two-dimensional ultrasound parameters have high diagnostic value in malignant thyroid nodules, and have certain correlation with HbA1c and TSH, which can be used for the diagnosis of malignant thyroid nodules.

Objective To investigate the clinical effect of transverse island fasciocutaneous penile flap in the treatment of meatus and navicular fossa stricture.Methods Fifteen patients with urethral reconstruction with transverse island fasciocutaneous penile flap from October 2014 to December 2018 were enrolled.Six patients had a history of urethroscopic surgery,three had a history of lichensclerosus,three had a history of urethral dilation,and three had no obvious causes.All patients underwent transverse incision under the coronal sulcus,and after fully dissecting the urethra,the urethra was opened longitudinally ventrally.After measuring the actual length of stenosis,the irradiance fascia flap with the corresponding length of the incision was reconstructed.The patients were reviewed at 1 and 3 months after operation,and any complications such as recurrence or urinary fistula were recorded.The urine flow rate was tested 3 months after surgery.Results All 15 patients in this group underwent a successfully operation.The actual measurement of urethral stricture length was 0.5-4.0 cm during operation,with the average of 2.82 cm.Three months after the operation,the urine flow rate ranged from 13.5 ml/s to 23.7 ml/s,with an average of 18.5 ml/s.The overall successful rate was 93.3％ (14/15).The rate of post-operative fistula was 20.0％ (3/15).Two cases complained of needle-like fistula at the incision.One case healed after 3 months,and the other gave up further treatment.One patient developed urethral stricture and urethral skin spasm again 1 month later and was surgically repaired again.Conclusions The initial experience of pedicled island fascia flap for the treatment of urethral stenosis and scaphoid stenosis is safe,feasible and effective for the treatment of urethral stricture.

Objective To compare the clinical characteristics and influence factors of hyperuricemia between genders,in order to provide references for better controlling and preventing the occurrence and development of hyperuricemiaprovide.Methods A total of 5 783 people who underwent physical examination in two Baoding Health Screening Centers from January 1st to June 1st,2016 were enrolled in this study,and all volunteers completed physical examination,laboratory examination and questionnaire survey.Patients with hyperuricemia were selected to analyse the clinical characteristics and influence factors.Results There were statistically significant differences in clinical characteristics,including obesity,blood pressure,blood glucose,blood lipids,liver function,renal function,anemia,blood rheology examination,thyroid ultrasound and lateral radiographs,between male and female patients with hyperuricemia (P＜0.05).The survey showed that there were statistically significant differences in age,education level,marital status,work status,sleeping status,smoking and drinking between male and female patients with hyperuricemia (P＜0.05).The red blood cells counts,marital status and education level were influence factors for female patients with hyperuricemia,while have little effect on male patients.The smoking,creatinine and diastolic blood pressure were influence factors for male patients with hyperuricemia,while have no effect on female patients.Conclusion The clinical characteristics and the influencing factors of male and female patients with hyperuricemia are different,so corresponding preventive and therapeutic measures should be taken for male and female patients.

Objective To observe the effects of salidroside regulating glucose metabolism in type 2 diabetic mice,then to explore the molecular mechanism. Methods Type 2 diabetes model was induced by feeding high-fat diet and intraperitoneal injecting STZ to male C56BL/6J mice,then the glucose related indexes,micro RNA-370 levels in the serum and liver tissue and the expression of gluconeogenesis key protein(G6Pase and PEPCK) in the liver tissue to observe the treatment effects of salidro-side on type 2 diabetic-caused gluose metabolic disorder.In cell test,we isolated primary hepatocytes,then silenced or over-ex-pressed micro RNA-370 in mouse primary hepatocytes to observe the molecular mechanism of glucose metabolic regulation of the micro RNA-370 and salidroside. Results Treated with salidroside 40,80 and 160 mg·kg-1,the results showed that compared with the model control group,the glucose related indexes were all improved significantly.The relative expression levels of micro RNA-370 in serum and liver,and that of PEPCK and G6Pase all reduced in different degrees,dose-dependently.The changes of middle and high dose group decreased significantly(P<0.05),that of low dose group had a decreasing trend but no statistically significant.In the cell test,compared with the normal control group,salidroside alone group and micro RNA-370 inhibitor group were able to reduce the protein expression level of PEPCK and G6Pase(P<0.05),micro RNA-370mimic alone group can signifi-cantly increase the protein expression level of PEPCK and G6Pase(P<0.05),compared with the micro RNA-370mimic alone group,combining micro RNA-370 mimic and salidroside can significantly reverse the increasing caused by micro RNA-370 mimic alone(P<0.05). Conclusion Our research found that salidroside can improve glucose metabolism disorder in type 2 diabetic mice,and at least in part,through the suppression of micro RNA-370 expression for the first time.